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Effect of hiatal hernia and esophagogastric junction morphology on esophageal motility: Evidence from high‐resolution manometry studies
Background High‐resolution Manometry (HRM) is the most sensitive and specific test available for clinical assessment of hiatal hernia (HH), a common condition defined as the separation between the Lower Esophageal Sphincter (LES) and crural diaphragm (CD). While the link between HH and Gastroesophag...
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| Published in: | Neurogastroenterology and motility 2024-12, Vol.36 (12), p.e14929-n/a |
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| creator | Kayali, Stefano Calabrese, Francesco Pasta, Andrea Marabotto, Elisa Bodini, Giorgia Furnari, Manuele Savarino, Edoardo V. Savarino, Vincenzo Giannini, Edoardo G. Zentilin, Patrizia |
| description | Background
High‐resolution Manometry (HRM) is the most sensitive and specific test available for clinical assessment of hiatal hernia (HH), a common condition defined as the separation between the Lower Esophageal Sphincter (LES) and crural diaphragm (CD). While the link between HH and Gastroesophageal Reflux Disease (GERD) is established, the potential association of HH with esophageal dysmotility, independently from GERD, is uncertain. This study aimed to analyze if HH, with or without GERD, can associate with esophageal motility disorders.
Methods
Consecutive patients without previous esophageal surgery who underwent HRM between 2018 and 2022 were enrolled. All patients with symptoms suggestive of GERD underwent impedance‐pH testing off‐therapy. HH was defined as a separation >1 cm between LES and CD, and esophagogastric junction (EGJ) morphology was classified as: Type I, when there was no separation between LES and CD; Type II, in case of minimal separation (>1 and |
| doi_str_mv | 10.1111/nmo.14929 |
| format | article |
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High‐resolution Manometry (HRM) is the most sensitive and specific test available for clinical assessment of hiatal hernia (HH), a common condition defined as the separation between the Lower Esophageal Sphincter (LES) and crural diaphragm (CD). While the link between HH and Gastroesophageal Reflux Disease (GERD) is established, the potential association of HH with esophageal dysmotility, independently from GERD, is uncertain. This study aimed to analyze if HH, with or without GERD, can associate with esophageal motility disorders.
Methods
Consecutive patients without previous esophageal surgery who underwent HRM between 2018 and 2022 were enrolled. All patients with symptoms suggestive of GERD underwent impedance‐pH testing off‐therapy. HH was defined as a separation >1 cm between LES and CD, and esophagogastric junction (EGJ) morphology was classified as: Type I, when there was no separation between LES and CD; Type II, in case of minimal separation (>1 and <3 cm); Type III, when ≥3 cm of separation was present. Demographic and clinical characteristics were collected at baseline, including Age, Gender, Alcohol‐, Coffee‐ and Smoke‐habits, GERD diagnosis and symptoms' duration. Two cohorts of patients, with and without HH, were retrospectively individuated, and their association with Ineffective Peristalsis, Hypercontractile Esophagus and Outflow Obstruction was analyzed with univariate and multivariate Logistic regressions using the statistical software R.
Key Results
848 consecutive patients were enrolled, and 295 cases of HH (34.8%), subdivided into 199 (23.5%) Type II‐ and 96 (11.3%) Type III‐EGJ patients, were identified. Ineffective peristalsis was diagnosed in 162 (19.1%) subjects, Hypercontractile esophagus in 32 (3.8%), and Outflow Obstruction in 91 (10.7%), while GERD was present in 375 (44.2%) patients. HH was significantly associated with Ineffective Peristalsis (p < 0.001) and GERD (p < 0.001). Furthermore, HH resulted to be a risk factor for Ineffective peristalsis (OR 2.0, 95% CI 1.4–2.8, p < 0.001) both when the analysis was conducted in all the 848 subjects, independently from GERD, and when it was carried out in patients without GERD (OR 2.3, 95% CI 1.02–5.3, p = 0.04). The risk for Ineffective Peristalsis increased 1.3 times for every centimeter of HH. No statistically significant association was found between HH and Outflow obstruction or Hypercontractile Esophagus.
Conclusions & Inferences
An increasing separation between the LES and CD may lead to a gradual and significant elevation in the risk of Ineffective Peristalsis. Interestingly, this association with HH is true in patients with and in those without GERD, suggesting that the anatomical alteration seems to play a major role in motility change.
848 patients underwent Esophageal High‐Resolution Manometry. Significantly increased risk for Esophageal Hypomotility in those with Hiatal Hernia, independently from GERD. Hypothesis of a “continuity spectrum” that progressively links Hiatal Hernia to Esophageal Hypomotility to GERD.</description><identifier>ISSN: 1350-1925</identifier><identifier>ISSN: 1365-2982</identifier><identifier>EISSN: 1365-2982</identifier><identifier>DOI: 10.1111/nmo.14929</identifier><identifier>PMID: 39344398</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Coffee ; Diaphragm ; esophageal hypomotility ; esophageal motility disorders ; Esophageal Motility Disorders - diagnosis ; Esophageal Motility Disorders - physiopathology ; Esophageal sphincter ; esophagogastric junction ; Esophagogastric Junction - physiopathology ; Esophagus ; Female ; Gastroesophageal reflux ; Gastroesophageal Reflux - diagnosis ; Gastroesophageal Reflux - physiopathology ; Hernia ; Hernia, Hiatal - physiopathology ; hiatal hernia ; Hiatal hernias ; high resolution manometry ; Humans ; ineffective peristalsis ; Male ; Manometry - methods ; Middle Aged ; Morphology ; Motility ; Patients ; Peristalsis ; Retrospective Studies ; Risk factors ; Sensitivity analysis ; Sphincter ; Statistical analysis</subject><ispartof>Neurogastroenterology and motility, 2024-12, Vol.36 (12), p.e14929-n/a</ispartof><rights>2024 John Wiley & Sons Ltd.</rights><rights>Copyright © 2024 John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2439-86cfbdb98fbdb9c19f055d173fcec9a071bd3c4f1a6f3fcf95ff0047ce5ab73b3</cites><orcidid>0000-0001-6803-1952 ; 0000-0002-3187-2894 ; 0000-0003-4685-1276</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39344398$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kayali, Stefano</creatorcontrib><creatorcontrib>Calabrese, Francesco</creatorcontrib><creatorcontrib>Pasta, Andrea</creatorcontrib><creatorcontrib>Marabotto, Elisa</creatorcontrib><creatorcontrib>Bodini, Giorgia</creatorcontrib><creatorcontrib>Furnari, Manuele</creatorcontrib><creatorcontrib>Savarino, Edoardo V.</creatorcontrib><creatorcontrib>Savarino, Vincenzo</creatorcontrib><creatorcontrib>Giannini, Edoardo G.</creatorcontrib><creatorcontrib>Zentilin, Patrizia</creatorcontrib><title>Effect of hiatal hernia and esophagogastric junction morphology on esophageal motility: Evidence from high‐resolution manometry studies</title><title>Neurogastroenterology and motility</title><addtitle>Neurogastroenterol Motil</addtitle><description>Background
High‐resolution Manometry (HRM) is the most sensitive and specific test available for clinical assessment of hiatal hernia (HH), a common condition defined as the separation between the Lower Esophageal Sphincter (LES) and crural diaphragm (CD). While the link between HH and Gastroesophageal Reflux Disease (GERD) is established, the potential association of HH with esophageal dysmotility, independently from GERD, is uncertain. This study aimed to analyze if HH, with or without GERD, can associate with esophageal motility disorders.
Methods
Consecutive patients without previous esophageal surgery who underwent HRM between 2018 and 2022 were enrolled. All patients with symptoms suggestive of GERD underwent impedance‐pH testing off‐therapy. HH was defined as a separation >1 cm between LES and CD, and esophagogastric junction (EGJ) morphology was classified as: Type I, when there was no separation between LES and CD; Type II, in case of minimal separation (>1 and <3 cm); Type III, when ≥3 cm of separation was present. Demographic and clinical characteristics were collected at baseline, including Age, Gender, Alcohol‐, Coffee‐ and Smoke‐habits, GERD diagnosis and symptoms' duration. Two cohorts of patients, with and without HH, were retrospectively individuated, and their association with Ineffective Peristalsis, Hypercontractile Esophagus and Outflow Obstruction was analyzed with univariate and multivariate Logistic regressions using the statistical software R.
Key Results
848 consecutive patients were enrolled, and 295 cases of HH (34.8%), subdivided into 199 (23.5%) Type II‐ and 96 (11.3%) Type III‐EGJ patients, were identified. Ineffective peristalsis was diagnosed in 162 (19.1%) subjects, Hypercontractile esophagus in 32 (3.8%), and Outflow Obstruction in 91 (10.7%), while GERD was present in 375 (44.2%) patients. HH was significantly associated with Ineffective Peristalsis (p < 0.001) and GERD (p < 0.001). Furthermore, HH resulted to be a risk factor for Ineffective peristalsis (OR 2.0, 95% CI 1.4–2.8, p < 0.001) both when the analysis was conducted in all the 848 subjects, independently from GERD, and when it was carried out in patients without GERD (OR 2.3, 95% CI 1.02–5.3, p = 0.04). The risk for Ineffective Peristalsis increased 1.3 times for every centimeter of HH. No statistically significant association was found between HH and Outflow obstruction or Hypercontractile Esophagus.
Conclusions & Inferences
An increasing separation between the LES and CD may lead to a gradual and significant elevation in the risk of Ineffective Peristalsis. Interestingly, this association with HH is true in patients with and in those without GERD, suggesting that the anatomical alteration seems to play a major role in motility change.
848 patients underwent Esophageal High‐Resolution Manometry. Significantly increased risk for Esophageal Hypomotility in those with Hiatal Hernia, independently from GERD. Hypothesis of a “continuity spectrum” that progressively links Hiatal Hernia to Esophageal Hypomotility to GERD.</description><subject>Adult</subject><subject>Aged</subject><subject>Coffee</subject><subject>Diaphragm</subject><subject>esophageal hypomotility</subject><subject>esophageal motility disorders</subject><subject>Esophageal Motility Disorders - diagnosis</subject><subject>Esophageal Motility Disorders - physiopathology</subject><subject>Esophageal sphincter</subject><subject>esophagogastric junction</subject><subject>Esophagogastric Junction - physiopathology</subject><subject>Esophagus</subject><subject>Female</subject><subject>Gastroesophageal reflux</subject><subject>Gastroesophageal Reflux - diagnosis</subject><subject>Gastroesophageal Reflux - physiopathology</subject><subject>Hernia</subject><subject>Hernia, Hiatal - physiopathology</subject><subject>hiatal hernia</subject><subject>Hiatal hernias</subject><subject>high resolution manometry</subject><subject>Humans</subject><subject>ineffective peristalsis</subject><subject>Male</subject><subject>Manometry - methods</subject><subject>Middle Aged</subject><subject>Morphology</subject><subject>Motility</subject><subject>Patients</subject><subject>Peristalsis</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Sensitivity analysis</subject><subject>Sphincter</subject><subject>Statistical analysis</subject><issn>1350-1925</issn><issn>1365-2982</issn><issn>1365-2982</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp1kT1P3TAUhi1UBJQy9A9Ulrq0Q8Af-TJbhW5bJChLmSPHOb7xVWJfbKdVNla2_sb-khpyYUCqh2Mf6_GjI78IvafklKZ1Zkd3SnPBxB46orwsMiZq9ubxXJCMClYcorchbAghJcvLA3TIBc9zLuoj9LDSGlTETuPeyCgH3IO3RmJpOwzBbXu5dmsZojcKbyaronEWj85veze49YxTt8MgPR5dNIOJ8zle_TIdWAVYezcm97r_e__HJ3SYFoW0boToZxzi1BkI79C-lkOAk91-jG6_rn5efM-ubr5dXny5yhRLI2d1qXTbtaJ-qooKTYqioxXXCpSQpKJtx1WuqSx1utOi0JqQvFJQyLbiLT9Gnxbv1ru7CUJsRhMUDIO04KbQ8PSjjLCcsIR-fIVu3ORtmi5RrCrLmjKaqM8LpbwLwYNutt6M0s8NJc1jPk3Kp3nKJ7EfdsapHaF7IZ8DScDZAvw2A8z_NzU_rm8W5T9Mb58e</recordid><startdate>202412</startdate><enddate>202412</enddate><creator>Kayali, Stefano</creator><creator>Calabrese, Francesco</creator><creator>Pasta, Andrea</creator><creator>Marabotto, Elisa</creator><creator>Bodini, Giorgia</creator><creator>Furnari, Manuele</creator><creator>Savarino, Edoardo V.</creator><creator>Savarino, Vincenzo</creator><creator>Giannini, Edoardo G.</creator><creator>Zentilin, Patrizia</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6803-1952</orcidid><orcidid>https://orcid.org/0000-0002-3187-2894</orcidid><orcidid>https://orcid.org/0000-0003-4685-1276</orcidid></search><sort><creationdate>202412</creationdate><title>Effect of hiatal hernia and esophagogastric junction morphology on esophageal motility: Evidence from high‐resolution manometry studies</title><author>Kayali, Stefano ; Calabrese, Francesco ; Pasta, Andrea ; Marabotto, Elisa ; Bodini, Giorgia ; Furnari, Manuele ; Savarino, Edoardo V. ; Savarino, Vincenzo ; Giannini, Edoardo G. ; Zentilin, Patrizia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2439-86cfbdb98fbdb9c19f055d173fcec9a071bd3c4f1a6f3fcf95ff0047ce5ab73b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Coffee</topic><topic>Diaphragm</topic><topic>esophageal hypomotility</topic><topic>esophageal motility disorders</topic><topic>Esophageal Motility Disorders - diagnosis</topic><topic>Esophageal Motility Disorders - physiopathology</topic><topic>Esophageal sphincter</topic><topic>esophagogastric junction</topic><topic>Esophagogastric Junction - physiopathology</topic><topic>Esophagus</topic><topic>Female</topic><topic>Gastroesophageal reflux</topic><topic>Gastroesophageal Reflux - diagnosis</topic><topic>Gastroesophageal Reflux - physiopathology</topic><topic>Hernia</topic><topic>Hernia, Hiatal - physiopathology</topic><topic>hiatal hernia</topic><topic>Hiatal hernias</topic><topic>high resolution manometry</topic><topic>Humans</topic><topic>ineffective peristalsis</topic><topic>Male</topic><topic>Manometry - methods</topic><topic>Middle Aged</topic><topic>Morphology</topic><topic>Motility</topic><topic>Patients</topic><topic>Peristalsis</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Sensitivity analysis</topic><topic>Sphincter</topic><topic>Statistical analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kayali, Stefano</creatorcontrib><creatorcontrib>Calabrese, Francesco</creatorcontrib><creatorcontrib>Pasta, Andrea</creatorcontrib><creatorcontrib>Marabotto, Elisa</creatorcontrib><creatorcontrib>Bodini, Giorgia</creatorcontrib><creatorcontrib>Furnari, Manuele</creatorcontrib><creatorcontrib>Savarino, Edoardo V.</creatorcontrib><creatorcontrib>Savarino, Vincenzo</creatorcontrib><creatorcontrib>Giannini, Edoardo G.</creatorcontrib><creatorcontrib>Zentilin, Patrizia</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Neurogastroenterology and motility</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kayali, Stefano</au><au>Calabrese, Francesco</au><au>Pasta, Andrea</au><au>Marabotto, Elisa</au><au>Bodini, Giorgia</au><au>Furnari, Manuele</au><au>Savarino, Edoardo V.</au><au>Savarino, Vincenzo</au><au>Giannini, Edoardo G.</au><au>Zentilin, Patrizia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of hiatal hernia and esophagogastric junction morphology on esophageal motility: Evidence from high‐resolution manometry studies</atitle><jtitle>Neurogastroenterology and motility</jtitle><addtitle>Neurogastroenterol Motil</addtitle><date>2024-12</date><risdate>2024</risdate><volume>36</volume><issue>12</issue><spage>e14929</spage><epage>n/a</epage><pages>e14929-n/a</pages><issn>1350-1925</issn><issn>1365-2982</issn><eissn>1365-2982</eissn><abstract>Background
High‐resolution Manometry (HRM) is the most sensitive and specific test available for clinical assessment of hiatal hernia (HH), a common condition defined as the separation between the Lower Esophageal Sphincter (LES) and crural diaphragm (CD). While the link between HH and Gastroesophageal Reflux Disease (GERD) is established, the potential association of HH with esophageal dysmotility, independently from GERD, is uncertain. This study aimed to analyze if HH, with or without GERD, can associate with esophageal motility disorders.
Methods
Consecutive patients without previous esophageal surgery who underwent HRM between 2018 and 2022 were enrolled. All patients with symptoms suggestive of GERD underwent impedance‐pH testing off‐therapy. HH was defined as a separation >1 cm between LES and CD, and esophagogastric junction (EGJ) morphology was classified as: Type I, when there was no separation between LES and CD; Type II, in case of minimal separation (>1 and <3 cm); Type III, when ≥3 cm of separation was present. Demographic and clinical characteristics were collected at baseline, including Age, Gender, Alcohol‐, Coffee‐ and Smoke‐habits, GERD diagnosis and symptoms' duration. Two cohorts of patients, with and without HH, were retrospectively individuated, and their association with Ineffective Peristalsis, Hypercontractile Esophagus and Outflow Obstruction was analyzed with univariate and multivariate Logistic regressions using the statistical software R.
Key Results
848 consecutive patients were enrolled, and 295 cases of HH (34.8%), subdivided into 199 (23.5%) Type II‐ and 96 (11.3%) Type III‐EGJ patients, were identified. Ineffective peristalsis was diagnosed in 162 (19.1%) subjects, Hypercontractile esophagus in 32 (3.8%), and Outflow Obstruction in 91 (10.7%), while GERD was present in 375 (44.2%) patients. HH was significantly associated with Ineffective Peristalsis (p < 0.001) and GERD (p < 0.001). Furthermore, HH resulted to be a risk factor for Ineffective peristalsis (OR 2.0, 95% CI 1.4–2.8, p < 0.001) both when the analysis was conducted in all the 848 subjects, independently from GERD, and when it was carried out in patients without GERD (OR 2.3, 95% CI 1.02–5.3, p = 0.04). The risk for Ineffective Peristalsis increased 1.3 times for every centimeter of HH. No statistically significant association was found between HH and Outflow obstruction or Hypercontractile Esophagus.
Conclusions & Inferences
An increasing separation between the LES and CD may lead to a gradual and significant elevation in the risk of Ineffective Peristalsis. Interestingly, this association with HH is true in patients with and in those without GERD, suggesting that the anatomical alteration seems to play a major role in motility change.
848 patients underwent Esophageal High‐Resolution Manometry. Significantly increased risk for Esophageal Hypomotility in those with Hiatal Hernia, independently from GERD. Hypothesis of a “continuity spectrum” that progressively links Hiatal Hernia to Esophageal Hypomotility to GERD.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>39344398</pmid><doi>10.1111/nmo.14929</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-6803-1952</orcidid><orcidid>https://orcid.org/0000-0002-3187-2894</orcidid><orcidid>https://orcid.org/0000-0003-4685-1276</orcidid></addata></record> |
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| ispartof | Neurogastroenterology and motility, 2024-12, Vol.36 (12), p.e14929-n/a |
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| source | Wiley |
| subjects | Adult Aged Coffee Diaphragm esophageal hypomotility esophageal motility disorders Esophageal Motility Disorders - diagnosis Esophageal Motility Disorders - physiopathology Esophageal sphincter esophagogastric junction Esophagogastric Junction - physiopathology Esophagus Female Gastroesophageal reflux Gastroesophageal Reflux - diagnosis Gastroesophageal Reflux - physiopathology Hernia Hernia, Hiatal - physiopathology hiatal hernia Hiatal hernias high resolution manometry Humans ineffective peristalsis Male Manometry - methods Middle Aged Morphology Motility Patients Peristalsis Retrospective Studies Risk factors Sensitivity analysis Sphincter Statistical analysis |
| title | Effect of hiatal hernia and esophagogastric junction morphology on esophageal motility: Evidence from high‐resolution manometry studies |
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